Navigating long-term disability (LTD) benefits can be challenging, and one of the biggest hurdles is the change of definition (COD) transition—a critical shift that can put your benefits at risk. In this change of definition LTD guide, I break down what this change means, why insurers use it to cut people off, and how you can protect your benefits. Understanding this shift could mean the difference between keeping your financial support or facing a sudden loss of income.
Let’s dive in.
Change of definition LTD example
Most people first learn about the long-term disability change of definition by getting a letter from the insurance company. This can happen early, such as in your claim approval letter, or it can occur in the year leading up to the change of definition.
Here is an example of what one of these change of definition LTD letters looks like:
As you can see, this letter warns you of the upcoming change of definition of disability. The definition changes from being unable to do your “own occupation” to being unable to do “any occupation.” Generally speaking, it is easier to prove you can’t do the essential duties of your own occupation than it is to prove you can’t do the essential duties of any occupation.
For example, I am a lawyer. Believe it or not, the essential duties of being a lawyer are tough! Especially the mental demands and stress. So, it is easier for me to prove a disability prevents me from doing the duties of a lawyer than it is to prove I can’t do any other job. One that is easier than being a lawyer, with less mental demands, stress, etc.
What is the definition of total disability?
Most long-term disability policies have a two-part definition of “total disability” that includes both the “own occupation” and “any occupation” criteria. Here is a typical example:
Own occupation: Before the change of definition
The own occupation definition of disability usually applies for the first two years. Own occupation is not always defined in the policy, but it refers to the employment you had when you became unable to work because of disability. It is not your specific job with your employer. Instead, it relates to your occupation in general with your employer or any other employer.
In this example, you would qualify for long-term disability benefits for two years if you can prove that you can’t perform the essential duties of your own occupation due to an illness or injury.
Any occupation: After the Change of Definition
The any occupation definition of disability is more nuanced than own occupation. The courts have not given a literal interpretation to his clause.
However, there are two things to know:
First, “any” occupation does not literally refer to all possible occupations. As you can see in the above example (part b), it has to be an occupation where you could earn at least 75% of your pre-disability earnings. Please note that most policies DO NOT include a reference to a percentage of pre-disability earnings. Most are silent on this. This makes it more difficult to determine if you meet the criteria for disability from any occupation. Even without a reference to a percentage, some judges will interpret any occupation clauses to mean at least 60% of your pre-disability earnings, but not always.
Second, the “any occupation” definition refers to occupations that you may “reasonably become qualified by training, education or experience.” The younger you are, the more likely it is the insurance company will argue that you are capable of retaining a job that would enable you to earn 75% or more of your pre-disability earnings. It is rare for insurance companies to pay for you to be retrained, but it can happen sometimes. Most often, they will just assert that you already have the skills needed to do jobs that qualify under the “any occupation” clause.
For more information on your own and any occupation, check out our article: Disability Insurance: Own Occupation vs Any Occupation.
What happens in the months leading up to the change of definition?
In the months leading up to the change of definition, the insurance company will gather information about you. They will seek updates from your doctor and other treatment providers. They may arrange for you to undergo vocational or medical assessments. Sometimes, you will attend these assessments, but other times, they do it behind the scenes without your knowledge. Examples of behind-the-scenes reports include transferrable skills assessments and internal medical reviews by insurance company doctors.
As you get closer to the change of definition date, the insurance company will notify you if your claim ends. Unfortunately, insurance companies will wrongfully deny many long-term disability claims at the change of definition. It is a convenient time for them to do so.
If the insurance company denies your claim in this way, don’t simply accept it. Remember, any occupation doesn’t mean all possible occupations. This is a nuanced definition, and you should seek advice from an experienced disability lawyer. Even if you are considering a return to work, it may be in your best interests to appeal the decision just in case your return to work fails.
Need guidance? Click on the button below or call (888) 480-9050 for a free consultation with our experienced team. We have helped thousands of Canadians successfully appeal wrongful long-term disability denials.
Medical and legal challenges with the LTD change of definition
It’s common for insurance companies to require claimants to undergo an Independent Medical Examination (IME) before the change of definition stage of a disability claim. These exams are intended to evaluate your current medical condition, functional limitations, and ability to work. Essentially, the insurer is looking for evidence to determine if you can perform “any occupation.”
While it’s natural to feel skeptical about these assessments—since they’re arranged by the insurance company—it’s crucial to cooperate fully. Refusing to attend or being uncooperative can be seen as a violation of your legal obligations under your policy and may lead to a denial of your disability benefits.
To protect yourself, familiarize yourself with the terms of your insurance policy and take detailed notes during the IME. Record the name of the examiner, what questions were asked, what activities were required of you, and how long the exam lasted. Afterward, you have the right to request a copy of the IME report. Be prepared that the report may contradict the findings of your own medical team, often concluding that you’re fit to return to work.
Related reading: What is a Transferable Skills Analysis?
Our success stories
The two-year mark is a turning point for long-term disability claims, and many people face increased pressure from insurers to participate in rehabilitation programs or return to work—often before they’re ready. Without proper guidance, it’s easy to make mistakes that can lead to a loss of benefits.
At Resolute Legal, we help clients understand their rights, gather strong medical and vocational evidence, and challenge unfair denials. Whether it’s advising on insurer-recommended programs, appealing a cut-off, or negotiating a fair settlement, we ensure our clients have a clear plan to protect their financial future.
A software engineer we represented was pressured into a return-to-work program right before the change of definition mark despite not being ready. They feared losing their benefits but didn’t know how to push back. We connected them with a certified rehabilitation professional, worked with their doctors to document their limitations, and developed a structured return-to-work plan that balanced compliance with protecting their health. As a result, their benefits were approved to continue, securing their financial stability. It was clear to the rehabilitation specialist that this person could not work in any capacity.
For anyone approaching the two-year mark, this period can feel overwhelming—but you don’t have to go through it alone. Resolute Legal is here to guide you every step of the way. Schedule a free consultation today.
Key takeaways on LTD change of definition
- The change of definition is a critical shift: Around the two-year mark, the definition of disability in most long-term disability (LTD) policies changes from “own occupation” to “any occupation,” making it harder to qualify for benefits.
- “Own occupation” vs. “any occupation”: Initially, benefits are granted if you cannot perform your specific occupation. After two years, you must prove that you cannot perform any occupation for which you are reasonably qualified based on your education, training, or experience.
- Insurance companies use the change of definition to cut off claims: Many insurers conduct assessments and reviews leading up to this transition to justify terminating benefits. These include vocational assessments, medical reviews, and independent medical examinations (IMEs).
- “Any occupation” doesn’t mean any job: The definition is nuanced. Courts have interpreted “any occupation” to mean work where you can earn a reasonable percentage (often 60-75%) of your pre-disability earnings—not just any job.
- Be prepared for assessments and reviews: Insurance companies may require medical exams, functional evaluations, or vocational assessments. It’s essential to cooperate but also document your experience, request copies of reports, and seek legal advice if needed.
- Many claims are wrongfully denied at the change of definition: Insurers often deny claims at this stage, assuming claimants can transition to another job. If this happens, don’t accept the decision outright—appeals are possible, and legal support can help.
- Legal and medical support can make a difference: Seeking assistance from a disability lawyer and ensuring strong medical evidence can improve your chances of maintaining benefits beyond the change of definition period.
- Success stories show the importance of advocacy: Many claimants, like a software engineer we represented, have successfully navigated the transition with legal support, securing their benefits when insurers pressured them to return to work prematurely.
- You don’t have to face the change of definition alone: If you’re approaching the two-year mark, understanding your rights and having a strategy in place can help protect your financial stability. Resolute Legal offers guidance and support to ensure you receive the benefits you deserve.
Need help navigating your LTD claim? Schedule a free consultation today.
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